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DOI: 10.1055/a-0785-1655
Chirurgische Zugänge zum Tibiakopf
Surgical Approaches to the Tibial PlateauPublikationsverlauf
Publikationsdatum:
04. Februar 2019 (online)
Zusammenfassung
Intraartikuläre Tibiakopffrakturen sind häufig komplex und können eine große chirurgische Herausforderung darstellen. Das Ziel der operativen Versorgung ist die anatomische stufenlose Gelenkrekonstruktion. Die Frakturmorphologie erfordert eine frakturspezifische Zugangsstrategie, welche entscheidende Voraussetzung für ein gutes postoperatives Ergebnis ist. Um eine komplette visuelle Einsicht über die frakturierten Gelenkflächen zu erlangen, können die verschiedenen Zugänge kombiniert oder bedarfsweise erweitert werden. Dabei kann durch eine laterale oder mediale femorale Epikondylenosteotomie die Einsicht auf die betroffene Gelenkfläche maßgeblich verbessert werden. Darüber hinaus ist zu beachten, dass dorsale Anteile der Gelenkfläche meist nur mit dorsalen Zugängen visualisiert werden können! Auch die geplante Positionierung von Platten und Schrauben sollte in der Zugangswahl Berücksichtigung finden!
Abstract
Tibial plateau fractures are often complex and can be a major surgical challenge. The aim of the operative treatment is the anatomical and steppless reconstruction of the articular surfacejoint. The morphology of the fracture requires a fracture-specific surgical approach to achieve a good postoperative outcome. To gain complete visualization of the articular surface surgical approaches can be combined or expanded as needed. A lateral or medial femoral epicondyle osteotomy can significantly improve the visualization into the affected articular surface. Furthermore it is important that the dorsal parts of the articular surface can usually only be visualized with dorsal approaches! Also the planned positioning of plates and screws should be considered before selecting of the approach!
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